Lung function trajectories in asthmatic children after the onset of omalizumab

ABSTRACT
Children with severe asthma are at risk of long-term lung function impairment. In those receiving biologic treatments such as omalizumab (OZ), the medium-term evolution of lung function has shown variability.
In this retrospective single-center study, we recorded data, including lung function, from asthmatic children who started on OZ between 2012 and 2015, with at least two follow-up visits over a period of no less than two years. We determined the course of forced expiratory volume in 1 s expressed as percentage predicted (FEV₁%) in each patient by constructing the annual slope and testing the significance of its trend (positive = improvement, negative = loss, or null). Pre-bronchodilator (pre-BD) and post-BD FEV₁% slopes were determined.
The 71 children included (55 male, 57 atopic) had been started on OZ at a mean age of 11.7 (2.9), when the mean dose of inhaled corticosteroids treatment (ICS) was 1245 (856) µg/day. Asthma disease was poorly or partially controlled in 37 and 24 children, respectively. During the follow-up (mean 5.7 (2.1) years), the majority of children did not modify their pre-BD or post-BD FEV₁% slopes (59, 83%, 95% CI: 72%-91%, and 57, 80%, 95% CI: 69%-89%, respectively). Meanwhile, clinical asthma control significantly improved (P < 0.0001) and the ICS dose significantly decreased to 906 (649) µg/day (P = 0.01).
In conclusion, the real-life long-term evolution of lung function in children with severe asthma started on OZ is stable. This is accompanied by improved clinical asthma control and a reduction in the burden of ICS treatment.